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A new index for assessing surgical outcome in unilateral cleft lip and palate subjects aged five: reproducibility and
N E Atack1, I S Hathorn, G Semb
1University of Bristol, United Kingdom.
Insights
A new index reliably assesses surgical outcomes in children with unilateral cleft lip and palate (UCLP). While reproducible, it cannot predict future growth needs from early models.
Area of Science:
- Craniofacial Surgery
- Pediatric Plastic Surgery
- Dental and Maxillofacial Radiology
Background:
- Assessing surgical outcomes in children with unilateral cleft lip and palate (UCLP) is crucial for long-term management.
- Existing indices may not allow for early assessment of surgical outcomes in UCLP patients.
- The authors previously developed a novel index for this purpose.
Purpose of the Study:
- To evaluate the reproducibility, reliability, and predictive validity of a new index for assessing surgical outcomes in 5-year-old children with UCLP.
- To compare early assessments with outcomes in late adolescence.
Main Methods:
- Sixty study models from 5- to 6-year-old UCLP subjects were assessed using the developed index.
- Longitudinal models of 54 subjects at ages 16–18 were acquired after orthodontic treatment (no orthognathic surgery).
- The need for osteotomy was assessed in both age groups.
Main Results:
- The index demonstrated excellent intra-examiner and good inter-examiner agreement.
- 13-18% of 5-year-old models suggested a potential need for orthognathic surgery.
- At 16–18 years, 9% of models indicated a potential benefit from osteotomy, but individual prediction from age 5 models was not possible.
Conclusions:
- The developed index is reliable and reproducible for early surgical outcome assessment in UCLP.
- While face validity appears strong, true predictive validation was not achieved in this study.
- The index offers an earlier assessment tool compared to existing methods.
Objective:
This study assessed the reproducibility, reliability, and predictive validity of a previously developed index by the authors for assessing surgical outcome in unilateral cleft lip and palate (UCLP) children aged 5.
Methods:
Sixty randomly selected study models of 5- to 6-year-old complete UCLP subjects were obtained and the index was used to assess their surgical outcomes.
Results:
Assessment of these study models using the new index demonstrated excellent intra-examiner agreement. The inter-examiner agreement was shown to be good. The corresponding longitudinal models at 16 to 18 years of 54 of the initial 5- to 6-year-old sample were also acquired. These subjects had undergone orthodontic treatment but not orthognathic surgery. The need for osteotomy amongst these models was assessed. Between 13% and 18% (depending on examiner) of 5-year-olds' models were scored in the groups likely to require orthognathic surgery. In the corresponding 16- to 18-year-olds' models, 9% were assessed as likely to benefit from an osteotomy. However, on an individual basis, it was not possible to predict future growth from study models at age 5.
Conclusions:
This study has provided a reliable and reproducible index for assessing the outcome of surgery in UCLP subjects earlier than indices already available. True validation of the index was not possible but it appears that it relies on face validity.
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